Provider Demographics
NPI:1689663320
Name:ANSARI, NATHER B (MD)
Entity Type:Individual
Prefix:
First Name:NATHER
Middle Name:B
Last Name:ANSARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3910
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22402-3910
Mailing Address - Country:US
Mailing Address - Phone:540-288-9888
Mailing Address - Fax:540-288-0054
Practice Address - Street 1:1075 GARRISONVILLE RD
Practice Address - Street 2:SUITE 115
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-8600
Practice Address - Country:US
Practice Address - Phone:540-288-9888
Practice Address - Fax:540-288-0054
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-15
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057815207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
004034P04Medicare ID - Type Unspecified
G82599Medicare UPIN